CSR I - CareSource - Dayton, OH

Role and Responsibility:
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Assist members with routine service inquires including but not limited to; selecting a primary care physician, member benefit education, member identification cards, transportation

arrangements, issues with provider accessibility, eligibility inquires, resolving member complaints, identifying and filing member grievances

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Provide quality service by immediately responding to the member and/or providers requests and complaints, and appropriately routing issues to the correct department for

timely resolution


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Assist members with processing their premium payments


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Assist a provider with routine service inquires including but not limited to; verifying eligibility, explanation of benefits, claims and appeal procedures


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Capture member grievance, and relay appeals instructions for the appropriate line of business, including future lines of business


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Ensure all HIPAA and State requirements/regulations are adhered to at all times, in existing and future lines of business


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Research, follow up, and resolve all open/pending issues in a timely manner to ensure member satisfaction


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Build and strengthen member relationships by providing quality customer service


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Maintain knowledge and understanding of all processes and procedures


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Adhere to all departmental and company policies and procedures


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Maintain complete and accurate documentation of all of telephone and written communications


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Act as a mentor to new hire employees


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Screen members to determine Case Management needs, and refer when appropriate


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Appropriately route calls to support departments including Pharmacy, and Triage, for proper/expedited resolution


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Assist with non-phone work such as incoming faxes and web inquires


Perform any other job related instructions, as requested


Requirements


Education / Experience:
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High School Diploma or equivalent is required


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Two (2) years customer service experience is preferred


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Customer Service experience in a call center is preferred


Required Competencies / Knowledge / Skills:
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Computer proficiency with knowledge and experience in a “Windows” environment


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Typing speed of 35 words per minute (WPM)


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Strong written and communication skills


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Professional phone etiquette


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Proper use of grammar


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Ability to work in a fast paced environment


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Adaptable to a constantly changing environment


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Attention to detail


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Ability to multitask


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Ability to work independently and with a team


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Critical thinking and listening skills


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Decision making and problem solving skills


Licensure / Certification:
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None


Accountability:
Working Conditions:
General office environment; may be required to sit/stand for long periods of time



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